Community Health Workers: Critical Links between the Home

Environment and Health Care

Minnesota Healthy Homes and Communities

Statewide Convening, June 28, 2012

Joan Cleary, Interim Executive Director

Minnesota Community Health Worker Alliance

Presentation Outline

• Overview of the Community Health Worker (CHW) role

• Building blocks of Minnesota’s CHW field

• CHW models for healthy housing and communities

• Helpful resources

Minnesota CHW Alliance:

We are a broad-based partnership of CHWs and stakeholder organizations who work together to

advance the CHW field.

http://www.mnchwalliance.org/

Workforce

Education

Leadership

Objective:

Advance the

knowledge & skillset

of CHWs to serve

MN communities

Objective:

Share research and

strengthen policies to

fully realize CHW

impacts for better

health

Objective:

Foster CHW leadership

development for healthy

communities

Objective:

Improve access to

CHW services with

expanded

employment and

sustainable funding

Policy &

Research

CHW

MN CHW

Alliance Help achieve the Triple

Aim, address health

disparities, expand &

diversify the health care

workforce and foster

healthier communities

through CHW strategies

CHWs: An Emerging Profession

• Educate and connect underserved communities to care, coverage and support

• Work under different titles & in many settings

• Provide outreach, advocacy, patient education, care coordination, navigation, social support and informal counseling

• Trusted members of the communities they serve, with shared culture and life experiences

CHW Strategies:

Evidenced-based best practices

• Effectively address cultural, linguistic, literacy-related, socioeconomic and other barriers to health and social services

• Increase access and improve quality, cost- effectiveness and cultural competence of care

• Expand and diversify our health care workforce

• Organize and advocate for healthier communities

CHW Roles

CHWs help patients of all ages: •Prevent costly health conditions, diseases and injuries

•Access needed care, coverage & services

•Avoid unnecessary ER and hospital visits

•Navigate our complicated health care system

•Manage chronic illness and maintain quality of life

•Improve individual and family capacity

•Foster healthy homes and communities

CHW Roles, continued

CHWs help health providers, health plans & public health:

• Produce better outcomes

• Manage complex cases and reduce costs

• Find coverage options for the uninsured

• Educate, empower and activate patients for better health

• Deliver culturally-sensitive care

• Reach those who are vulnerable and/or hard-to-reach

• Effectively tackle health disparities

• Link to community services and organizations

CHW employer types and examples in Minnesota

Community-based Nonprofits

Clinics and Hospitals

Federally Qualified Health Centers

Public Health Departments

Dental Services

Mental Health Centers

CHW Profession & Benefits: Recognized by Leading

Public & Private Authorities

• American Public Health Association (APHA)

• Centers for Disease Control (CDC)

• Health Affairs

• Health Resources and Services Administration (HRSA)

• Institute of Medicine

• U.S. Dept. of Labor Standard Occupational Classification (DOL)

CHWs & Healthcare Reform • Centers for Medicare and Medicaid Services Workforce Innovation

Grants

• Patient-Centered Medical Homes

• Health Insurance Exchanges

• Three sections of the Affordable Care Act

–CDC grant (section 5313) to promote positive health behaviors and outcomes in medically underserved communities through Community Health Workers.

–National Health Care Workforce Commission (Sec 5101) includes CHWs as primary care professionals

–Area Health Education Centers (sec. 5403 Sec.751) add CHWs to mandate for interdisciplinary training of health professionals

MN CHW Building Blocks

• CHW scope of practice developed (2004)

• Standardized, competency-based 11 credit curriculum created by Healthcare Education Industry Partnership, leading to certificate (2003-2005); revised to 14 credit program (2010)

• Minnesota CHW Peer Network formed (2005)

• CHW payment legislation successfully introduced (2007) in follow-up to commissioned research on sustainable funding strategies (2006)

• Minnesota CHW Alliance formed as outgrowth of CHW Policy Council (2010) and incorporated as nonprofit (2011)

Minnesota CHW Scope of Practice

• Role 1: Bridge the gap between communities and the health and social service systems.

• Role 2: Promote wellness by providing culturally appropriate health information to clients and providers.

• Role 3: Assist in navigating the health and human services system.

• Role 4: Advocate for individual and community needs.

• Role 5: Provide direct services.

• Role 6: Build individual and community capacity.

MN CHW Curriculum

• Model curriculum was updated in 2010 to a required 14 credit certificate program

• MnSCU curriculum offered at no charge to post-secondary schools in Minnesota

• Sold to over 30 organizations outside of Minnesota

• Credits provide educational pathway for CHWs interested in other health careers

MN CHW Curriculum

• Role of the CHW – Core Competencies (9 credit hours) – Role, Advocacy and Outreach - 2

– Organization and Resources - 1

– Teaching and Capacity Building - 2

– Legal and Ethical Responsibilities - 1

– Coordination and Documentation - 1

– Communication and Cultural Competency - 2

• Role of the CHW – Health Promotion Competencies (3 credit hours)

• Role of CHW – Practice Competencies – Internship (2 credit hours)

MN CHW Curriculum

• Currently four schools offer the certificate program:

– Minneapolis Community and Technical College

– Rochester Community and Technical Collge

– St. Catherine University

– Summit Academy OIC

• An online option for rural MN is in the planning stages with a pilot scheduled to begin late summer 2012

CHW Peer Network Sponsored by Wellshare International

• Established in 2005 in follow-up to CHW

focus group research commissioned by the Blue Cross Foundation identified peer support and professional growth as priorities of practicing CHWs

• Goals:

– Improve resource sharing and information exchange among CHWs

– Create opportunities for peer mentoring and support

– Offer continuing education and professional development

http://www.wellshareinternational.org/chwpeernetwork

Current & Potential CHW Funding Models

Advancing CHW Practice and Utilization: The Focus on Financing National Fund for Medical Education, Center for the Health

Professions, UC-San Francisco, 2006.

• Foundation grants

• Government grants and contracts

• Medicaid & other coverage options

• Government general fund

• Private organizations

• Consumer/self-pay…no examples found

MHCP CHW Payment Legislation

• 2007 Legislation

– 12/19/07: Federal approval received

– MHCP enrollment criteria:

• CHW certificate from school offering MnSCU approved curriculum

• Supervised by a physician/advanced practice registered nurse

• Grandfathering provision

• 2008 Legislation

– 3/18/09: Federal approval of expansion of CHW supervision to the following provider types:

• Certified public health nurses operating under the direct authority of an enrolled unit of government

• Dentists

• 2009 Legislation

– Federal approval of supervision by Mental Health Professionals

MHCP CHW Payment Legislation

Minnesota Statute (MS 256B.0625, Subd. 49)

Covered Services

• Signed diagnosis-related order for patient education in patient record

• Face-to-face services, individual and group

• Standardized education curriculum consistent with established or recognized health or dental care standards

• Document all services provided

Provider Types Authorized to Bill for CHW Services

Advanced Practice Nurses Hospitals

Clinics Indian Health Services Facilities

Critical Access Hospitals Mental Health Professionals

Dentists Physicians

Family Planning Agencies Public Health Clinic Nurses

Tribal Health Facilities

To learn more, contact: Will.wilson@state.mn.us

Examine CHW strategies within framework to connect housing

conditions and health outcomes

• Housing quality & its role in safety and in physiological and psychological health

• Linked issues of housing affordability, residential stability and crowding

• Neighborhood and community attributes that impact health such as community design and concentration of poverty

Housing and Health: New Opportunities for Dialogue and Action. www.nchh.org

Spotlight: CHW models that

connect home environments to health care

• Asthma: New England Asthma Innovations Collaborative, King County Healthy Homes Demonstration Project

• Public Housing: HUD and NHLBI partnership for Hope VI Public Housing Cardiovascular Health Initiative

• Healthy Housing: Kresge Foundation Safety Net Enhancement Initiative

CHW Models, cont

• Primary Care Access for Homeless: 8 state demonstration to integrate CHWs into FQHCs to improve quality of care for homeless individuals through outreach and care coordination under leadership of National Health Care for the Homeless Council

Potential employment sites for

CHWs who address

housing –related health problems

• Primary care and Health Care Home clinics

• Home visiting programs

• Local Public Health

• Affordable housing for families and seniors

• Faith-based organizations

• School-based clinics

• Social service agencies & mutual assistance associations

• Hospital community benefit programs

• Health plan initiatives

Recommendations

• Partnerships: Build CHW strategies into the action plan for the Alliance for Healthy Housing and Communities

• Awareness-building: Educate health and housing stakeholders about the CHW role and its impacts

• Policy: Ensure that CHW workforce is included in state plan for healthy housing and in the Workforce Work Group priority recommendations

• Practice: Target asthma disparities reduction as starting point for comprehensive cross-sector health and housing intervention utilizing CHWs in team approach

• Capacity-building: Train CHWs in healthy housing

Trends that Impact Future CHW

Employment and Funding

• Move from volume-oriented payment to pay for performance and outcomes

• Workforce needs related to expanded coverage

• Demographic shifts with aging baby boomers and growth in populations of color

Trends, cont.

• Focus on team-based, patient-centered care with everyone “working at the top of their license”

• Greater recognition of social, environmental and economic determinants of health and use of tools such as community assessments and HIA

• Need for proven, integrated, lower cost models

• Increased accountability for reporting and outcomes, leading to wider adoption of strategies that address health disparities

Conclusion

CHW workforce strategies are an integral part of the

solution to successfully addressing the challenges at

the intersection of health, housing, and community

development and should be included in our agenda

for the Alliance for Healthy Housing and Communities.

Selected Resources

• Community Health Workers Evidence-based Models Toolbox. HRSA Office of Rural Health.2011.

• Brownstein JN et al. Addressing Chronic Disease through Community Health Workers: A Policy and Systems-Level Approach. CDC. 2011.

• Cleary J, Lee J and Itzkowitz V. CHWs in Minnesota: Bridging Barriers, Expanding Access, Improving Health. 2010. www.bcbsmnfoundation.org

• E-Learning: Promoting Policy and Systems Change to Expand Employment of CHWs

http://www.cdc.gov/dhdsp/pubs/chw_elearning.htm.

• Housing and Health: New Opportunities for Dialogue and Action. National Center

for Healthy Housing, Center for Housing Policy, ChangeLab Solutions and Trust for America’s Health. www.nchh.org

More Resources

• King County WA Healthy Homes Demonstration Project

http://www.nchh.org/Research/King-County-Healthy-Homes-Demonstration-Project.aspx

• NHLBI-HUD Partnership to improve heart health among public housing residents using CHW strategies

http://nhlbi.altaruminstitute.net/healthdisp/results/hud-hope-VI.htm

• Training on Healthy Housing for CHWs (English and Spanish versions) http://www.nchh.org/Training/HealthyHomesTrainingCenter/TrainingCourses/CHW/CourseMaterials.aspx

• Wilder Research Center CHW Assessment and ROI http://reg.miph.org/2012CancerSummit/presentationpdfs/Diaz.pdf

Q & A and Discussion

• What do you see as the opportunities and barriers for integrating CHWs into healthy housing efforts in Minnesota?

• What information or assistance would be helpful to introducing the CHW role to your organization and its work?

For more information:

Joan Cleary, Interim Director

Minnesota Community Health Worker Alliance

612-250-0902

joanlcleary@gmail.com

Thank you!